Yoga in Nepal

The History and Heritage of Yoga in Nepal

Nepal, a land renowned for its breathtaking Himalayan landscapes and spiritual serenity, holds a significant place in the history of yoga. As a physiotherapist and yoga therapist, understanding the rich heritage of yoga in Nepal not only deepens our appreciation of the practice but also enhances our therapeutic approaches.

Ancient Foundations and Vedic Influence

The roots of yoga in Nepal trace back to the Vedic period, over 5,000 years ago. The early Vedic texts, such as the Rigveda, contain the seeds of yogic philosophy and practice. These ancient scriptures, originating in the Indian subcontinent, profoundly influenced Nepal due to its close geographical and cultural connections with India.

Sages and rishis often sought the tranquility of the Himalayan region, including Nepal, for deep meditation and spiritual practices. This exchange of knowledge enriched the yogic traditions in both regions. Notably, Guru Gorakhnath, a pivotal figure in Hatha Yoga, is believed to have meditated in the caves of the Kathmandu Valley, further embedding yoga into Nepal's cultural and spiritual landscape.

The Role of Buddhism

The emergence of Buddhism in the 6th century BCE, with the enlightenment of Siddhartha Gautama (the Buddha) in Lumbini, Nepal, played a crucial role in shaping the yogic traditions of the region. Buddhist teachings emphasize meditation, mindfulness, and the pursuit of enlightenment—principles that align closely with yoga.

The interweaving of Hindu and Buddhist philosophies created a unique spiritual environment in Nepal. This confluence is evident in the many monasteries and temples where yoga and meditation are integral to daily life, enhancing the holistic approach to physical and mental well-being.

Medieval Period and Yogic Practices

During the medieval period, particularly under the Malla Dynasty (12th to 18th century), Nepal continued to thrive as a center for yogic practices. The dynasty’s support for arts and spirituality led to the construction of numerous temples and stupas, where advanced yoga and tantric practices were performed.

Texts such as the "Gheranda Samhita" and the "Hatha Yoga Pradipika" from this era highlight the sophisticated understanding and practice of yoga in Nepal. These texts underscore the integration of physical postures, breath control, and meditation, foundational elements in modern physiotherapy and yoga therapy.

Modern Revival and Integration

The 20th century marked a revival of yoga in Nepal, fueled by both local and international interest. The establishment of ashrams and yoga centers provided structured learning environments. Renowned spiritual figures like Swami Rama and Paramahansa Yogananda visited Nepal, spreading their teachings and inspiring a new generation of practitioners.

This period also saw yoga’s integration into health and wellness, aligning closely with modern therapeutic practices. Yoga retreats and teacher training programs in picturesque locations like Pokhara and the Kathmandu Valley offer holistic experiences that combine traditional practices with contemporary health techniques.

Contemporary Yoga in Nepal

Today, Nepal remains a prominent destination for yoga enthusiasts worldwide. The celebration of International Yoga Day with great enthusiasm reflects the country’s dedication to its yogic heritage. Nepal’s diverse yoga community includes traditional practitioners, modern instructors, and spiritual seekers, all contributing to a dynamic and evolving practice.

The majestic backdrop of the Himalayas provides an unparalleled setting for yoga retreats and meditation camps. Practicing yoga in such a serene environment enhances both physical and mental well-being, making it a valuable component of comprehensive physiotherapy and yoga therapy.

Embracing the Yogic Legacy

Understanding the history and heritage of yoga in Nepal enriches our therapeutic practices. This rich tapestry of ancient wisdom and spiritual devotion informs our approach, offering a holistic path to health and wellness. As we integrate these traditions into modern physiotherapy and yoga therapy, we provide our clients with a profound and transformative healing experience.

Nepal’s enduring yogic legacy continues to inspire and guide us in our quest for harmony and holistic well-being. Whether through targeted physical therapy or comprehensive yoga sessions, the principles rooted in Nepal’s yogic history enhance our ability to facilitate physical recovery and spiritual growth.

Yoga and Ayurveda in South India

A Journey Through Yoga and Ayurveda in South India



I recently co-hosted a yoga retreat in the South Indian state of Kerela. Kerela has a kong history of embracing physical disciplines such as yoga, Kerlari (South Indian Martial Art) and ancient holistic traditions like Ayurveda to rejuvenate mind, body, and spirit. As a physiotherapist and yoga teacher dedicated to evidence-based practice, this retreat provided a profound exploration of the synergy between these timeless disciplines and modern healthcare.



Exploring the Roots: Yoga in South India

South India boasts a rich heritage of yoga, deeply rooted in spiritual and cultural practices dating back thousands of years. From the classical texts of Patanjali's Yoga Sutras to the vibrant traditions preserved in Kerala's temples and ashrams, the region serves as a cradle for authentic yogic teachings. Our daily yoga sessions, guided by experienced instructors, immersed participants in the essence of traditional Hatha and Ashtanga practices, fostering physical strength, flexibility, and inner balance.





Ayurveda: The Science of Life

Complementing our yoga practice, we delved into the ancient science of Ayurveda, a holistic approach to wellness originating from the Indian subcontinent. With its emphasis on balancing the body's doshas (bioenergies) and nurturing harmony between mind, body, and environment, Ayurveda provided a profound framework for understanding individual health needs. Our meals, prepared with locally sourced ingredients and Ayurvedic principles, nourished not only our bodies but also cultivated a deeper connection to the natural rhythms of life.





Bridging Traditions with Evidence-Based Practice

As practitioners committed to evidence-based healthcare, we recognized the synergies between yoga, Ayurveda, and modern physiotherapy. By integrating ancient wisdom with contemporary research and clinical expertise, we curated a holistic approach to wellness that honors both tradition and innovation. Our daily ice baths, inspired by Ayurvedic principles of invigoration and rejuvenation, offered participants a unique opportunity to experience the therapeutic benefits of cold immersion, supported by scientific evidence in pain management and recovery.




Yoga on the Beach: A Symphony of Nature

Against the backdrop of Kovalam's pristine beaches, our yoga sessions transcended the confines of a studio, inviting participants to connect with nature's rhythms and the soothing embrace of the ocean. As waves crashed gently upon the shore, we synchronized breath with movement, fostering a sense of oneness with the elements and nurturing a profound sense of inner peace and tranquility.

The Vital Role of Physiotherapy in Managing and Treating Developmental Delay in Pediatric Patients

INTRODUCTION

Developmental delay in pediatric patients is a concern that affects children and their families worldwide. It encompasses a wide range of conditions where children fail to meet age-appropriate developmental milestones. These delays can significantly impact a child's physical, cognitive, and emotional development. In this article, we will explore the invaluable role that physiotherapy plays in the management and treatment of developmental delay in a pediatric setting.

UNDERSTANDING DEVELOPMENTAL DELAY

Developmental delay can manifest in various areas, including motor skills, speech and language, cognitive development, and social-emotional skills. In a pediatric context, developmental delay often refers to a delay in achieving physical milestones. These milestones can include activities like sitting up, crawling, walking, and other gross motor skills. When a child experiences delays in these areas, physiotherapy becomes a crucial intervention.

THE ROLE OF PHYSIOTHERAPY

1. Comprehensive Assessment: The journey of treating developmental delay begins with a comprehensive assessment conducted by a skilled pediatric physiotherapist. This assessment aims to identify the specific areas of delay, the underlying causes, and the child's unique needs.

2. Tailored Treatment Plans: Based on the assessment, a personalized treatment plan is developed. This plan may include exercises and activities designed to improve strength, balance, coordination, and motor skills in the child. These activities are carefully chosen to align with the child's developmental stage and abilities.

3. Early Intervention: Early intervention is key to addressing developmental delay effectively. Pediatric physiotherapists work closely with children from an early age to provide the necessary support and guidance. This early intervention can lead to significant improvements in a child's development.

4. Family-Centered Care: Physiotherapy for developmental delay is not limited to in-clinic sessions. Therapists also empower parents and caregivers with the knowledge and tools they need to continue the child's therapy at home. This collaborative approach ensures that therapy is integrated into the child's daily life.

5. Holistic Approach: Physiotherapy for developmental delay is not just about physical exercises. It encompasses a holistic approach that considers the child's overall well-being. Therapists focus on building the child's confidence, improving self-esteem, and promoting independence.

6. Monitoring and Progress Evaluation: Pediatric physiotherapists closely monitor a child's progress and make necessary adjustments to the treatment plan. Regular evaluations ensure that therapy remains effective and that the child continues to make strides in their development.

CONCLUSION

In the realm of pediatric healthcare, physiotherapy plays a pivotal role in managing and treating developmental delay. It offers hope to children and their families, empowering them to overcome challenges and achieve their full potential. Through early intervention, personalized treatment plans, and a holistic approach, pediatric physiotherapy provides the support needed to foster physical development, enhance motor skills, and improve the overall quality of life for children with developmental delays.

At Inner Focus Physiotherapy, we are committed to providing the highest level of care for pediatric patients experiencing developmental delays. Our team of dedicated pediatric physiotherapists is here to support your child on their journey towards reaching their developmental milestones. Contact us today to learn more about our services and how we can help your child thrive

Advancing Paediatric Physiotherapy: A Comprehensive Approach with a Focus on Holistic Practice


Introduction

With a career spanning over 18 years as a qualified physiotherapist, accredited Yoga Teacher, and APA accredited Pilates instructor, I have had the privilege of witnessing the profound impact of physiotherapy in countless patients. Within my practice, a particular area of significance is paediatric physiotherapy, where we embrace a holistic biopsychosocial approach to provide comprehensive care. This article delves into the myriad benefits of pediatric physiotherapy while highlighting our commitment to home visits and the provision of services funded through the NDIS (National Disability Insurance Scheme).

Embracing the Holistic Biopsychosocial Approach

In the realm of paediatric physiotherapy, the biopsychosocial model assumes paramount importance. This model acknowledges the intricate interplay of biological, psychological, and social factors in shaping a child's health and overall well-being. Recognizing this interconnectedness is critical as we address not only the physical aspects but also the emotional, behavioral, and social dimensions of a child's health.

Yoga Therapy: A Pivotal Component

My personal journey into yoga therapy began as a means to conquer a debilitating pelvic injury. Little did I know that this profound practice would become an indispensable facet of my physiotherapeutic repertoire. Yoga therapy transcends mere physical postures; it entails harnessing the mind-body connection to facilitate healing and well-being.

In paediatric physiotherapy, yoga therapy emerges as a transformative element. It nurtures body awareness, balance, and flexibility in children, while also promoting emotional resilience. Moreover, yoga empowers young patients to actively participate in their healing process, fostering self-awareness and self-care from an early age.

Holistic Practice: A Comprehensive Healing Experience

At Inner Focus Physiotherapy, we firmly believe that genuine healing extends beyond addressing physical symptoms in isolation. Our holistic approach seamlessly integrates diverse modalities, encompassing yoga therapy, clinical Pilates, and beyond, to offer all-encompassing care for our pediatric patients. This approach facilitates the tailoring of treatment plans that acknowledge the unique needs, capacities, and challenges of each child.

This holistic perspective enables us to address a spectrum of pediatric issues, ranging from developmental delays and musculoskeletal conditions to sports injuries and chronic pain. By comprehensively understanding the child and their environment, we can chart a more effective and enduring path to recovery.

Evidence-Based Practice: The Bedrock of Our Approach

In today's healthcare milieu, an evidence-based approach stands as the cornerstone of clinical practice. Paediatric physiotherapy adheres to this principle, and my unwavering commitment to remaining at the vanguard of research and education underscores our dedication to providing the highest quality care for young patients.

Our approach melds contemporary scientific knowledge, pain science, and evidence-based methodologies with yoga therapy and holistic practices, ensuring that the pediatric physiotherapy we deliver is both efficacious and secure.

Personalized Care: The Key to Optimal Outcomes

In my extensive experience, optimal outcomes in paediatric physiotherapy are realized through personalized care. We extend our services to include home visits, recognizing that the comfort and familiarity of a child's environment can contribute significantly to their progress. Through private or semi-private sessions, we concentrate on the individualized needs of each child, ensuring they receive the requisite attention and guidance for their distinctive journey to recovery.

Accessible Services Through NDIS Funding

Furthermore, it is our pleasure to announce that our paediatric physiotherapy services are now available and funded through the NDIS (National Disability Insurance Scheme). This means that children with disabilities can access the specialized care they require to enhance their physical function and overall quality of life.

Conclusion

In sum, pediatric physiotherapy, when approached through the lens of a holistic biopsychosocial model and fortified with yoga therapy and holistic practices, holds the potential to truly transform the lives of young patients. At Inner Focus Physiotherapy, we are resolutely committed to delivering evidence-based, personalized care, empowering children to surmount physical challenges and embrace a healthier, more fulfilling future.

As a physiotherapist and yoga teacher, I have borne witness to the remarkable strides young patients can achieve when equipped with the right tools and unwavering support.

Finding Balance: Exploring the Yoga and Surf Scene in Bali

Finding Balance: Exploring the Yoga and Surf Scene in Bali

Bali, an Indonesian paradise known for its vibrant culture and breathtaking landscapes, has long been a magnet for surfers and yogis seeking a harmonious blend of physical activity, spiritual exploration, and natural beauty. As a physiotherapist with a passion for yoga therapy, I cannot help but be captivated by Bali's thriving yoga and surf scene. In this blog post, we will delve into the fascinating fusion of yoga and surfing in Bali, uncovering the therapeutic benefits, and exploring the best destinations for those seeking to find balance through these two practices.

The Symbiotic Relationship:

Yoga and surfing may appear to be vastly different activities, but they share a remarkable symbiotic relationship. Yoga offers a holistic approach to physical and mental well-being, fostering strength, flexibility, and balance. Surfing, on the other hand, is a dynamic water sport that challenges the body's strength, stability, and adaptability. Together, these practices complement one another, providing a comprehensive mind-body experience that cultivates self-awareness, mindfulness, and connection with nature.

The Therapeutic Benefits:

Both yoga and surfing have numerous therapeutic benefits, making them ideal for individuals seeking physical rehabilitation, injury prevention, or stress relief.

Yoga Therapy: In Bali, the yoga scene offers a wide array of styles, from vigorous Vinyasa flows to gentle Yin practices. Yoga therapy, an emerging field, focuses on tailoring yoga practices to address specific physical or emotional conditions. Whether it's managing chronic pain, improving posture, or reducing stress levels, yoga therapy sessions can provide personalized guidance and modifications to support an individual's unique needs.

Surf Therapy: Surfing, often referred to as "blue therapy," combines the healing power of the ocean with the physical demands of riding waves. The rhythmic motion of paddling and the dynamic challenges of balancing on a surfboard engage multiple muscle groups, enhancing strength, endurance, and proprioception. Moreover, the immersive experience of being in the water can have a profoundly calming effect on the mind, promoting relaxation and stress reduction.

Best Yoga and Surf Destinations in Bali:

Now, let's explore some of the top destinations in Bali that offer a harmonious blend of yoga and surf experiences:

Canggu: Located on Bali's west coast, Canggu is a popular hotspot for both yogis and surfers. With its laid-back vibe, it boasts numerous yoga studios and surf schools catering to all levels of experience. Echo Beach and Batu Bolong Beach are ideal for catching waves, while The Practice and Serenity Eco Guesthouse are renowned yoga sanctuaries.

Uluwatu: Known for its stunning cliffside views and world-class surf breaks, Uluwatu is a mecca for experienced surfers. The Yoga Searcher Bali and Morning Light Yoga Studio offer serene spaces to practice yoga, with the ocean as your backdrop.

Ubud: Nestled in the heart of Bali's lush jungle, Ubud provides a tranquil setting for yoga enthusiasts. The Yoga Barn and Radiantly Alive are two prominent studios offering a diverse range of yoga classes. Though Ubud lacks the coastline for surfing, nearby destinations like Padang Padang and Bingin Beach are just a short drive away.

Conclusion:

For those seeking a harmonious blend of yoga, surf, and natural beauty, Bali is the perfect destination. Whether you're an experienced practitioner or a beginner looking to explore these practices, Bali's yoga and surf scene caters to all levels and provides a rich tapestry of experiences for physical, mental, and emotional well-being. So, pack your yoga mat and surfboard, embark on an adventure to the Island of the Gods, and discover the transformative power of finding balance through yoga and surfing in Bali.

Yoga Therapy for Cerebral Palsy

Yoga Therapy for Cerebral Palsy

The findings of a recent meta-analysis indicate that yoga offers similar functional benefits to exercise based physiotherapy modalities as a treatment intervention for individuals with MS, stroke and cerebral palsy, while also addressing broader secondary outcomes in a holistic fashion..

Benefits

The study observed improved outcomes in:

-        Spasticity

-        Fatigue

-        Strength,

-        Pain

-        BMI

-        Respiratory function

-        Reaction time

-        Cognition

-        Self-perception

-        Emotional health

-        Balance

-        Gait speed and endurance

-        Depression

-        Anxiety

-        Quality-of-life

The evidence demonstrates that yoga as an intervention that can help address aspects of the whole person, fulfilling the role of a biopsychosocial intervention.

Given the high level of evidence, yoga as an intervention shows great promise for children and adults with CP to effect change across domains of function and wellbeing.

Other unique benefits

Yoga is another option for individuals with CP for exercise, movement and rehabilitation.

For instance, modifications can be made to any yoga position to accommodate individual differences in flexibility, strength, and/or balance.

Additionally, Self-efficacy and confidence for physical activity capabilities develop through individualized movement sequences.

Complementing this are the effects of breathing and meditation to promote relaxation, mindfulness, and ease with physical activity.

Individuals with CP can benefit tremendously from experiencing success in a physical activity, which reinforces participation in movement.

A skilled instructor can develop individualized therapeutic yoga programs that progressively address deficits in flexibility, strength, and balance by changing pose position, props, and time held. Props can support, add comfort, and aid balance. For children and adults with intellectual abilities, the instructor can mirror the practice and add elements of playfulness.

The highest functional improvements across populations were obtained with yoga that occurred more than 60 min for three times per week. If this frequency is difficult to attain in the clinic, some studies had participants perform yoga once a week in the clinic and four times per week at home, and the outcomes were robust for anxiety and quality of life.

REFERENCE:
Veneri, D., Gannotti, M., Bertucco, M., & Fournier Hillman, S. E. (2018). Using the International Classification of Functioning, Disability, and Health Model to Gain Perspective of the Benefits of Yoga in Stroke, Multiple Sclerosis, and Children to Inform Practice for Children with Cerebral Palsy: A Meta-Analysis. The Journal of Alternative and Complementary Medicine, 24(5), 439–457. doi:10.1089/acm.2017.0030

Yoga for stroke rehabilitation

Yoga for stroke rehabilitation

Stroke is a major health issue and cause of long‐term disability and has a major emotional and socioeconomic impact.

Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.

Yoga is a mind‐body practice that originated in India, and which has become increasingly widespread in the Western world. Recent evidence highlights the positive effects of yoga for people with a range of physical and psychological health conditions.

A recent non‐Cochrane systematic review concluded that yoga can be used as self‐administered practice in stroke rehabilitation.

Studies reported a significant benefit in improving aspects of range of movement, and a significant benefit in reducing anxiety.

Additionally, after discharge from hospital or other stroke services, stroke survivors have to cope with the long‐term effects of stroke. Research has shown that yoga can help people with long‐term conditions to cope better. Yoga can also improve quality of life.

How the intervention might work

Traditionally, yoga practitioners are reputed to benefit physically and psychologically from yoga practice (Bower 2014).

Yoga is considered a physical activity (Sattelmair 2010) and as such has positive effects on brain chemistry and may lead to strengthened physical states (Garret 2011).

In addition, the relaxation and personal integration aspects of yoga contribute to mindful awareness and personal acceptance (Garret 2011), enhancing ability to sustain attention (Oken 2006).

Conclusion

The review suggested that yoga has evidence to support its use as part of patient‐centered stroke rehabilitation.

Yoga Therapy and Spinal Cord Injury

Yoga Therapy and Spinal Cord Injury

 

Therapeutic yoga is the application of movement, breathing exercises, cognitive strategies, education and the establishment of a genuine compassionate relationship.

In the above video is Clint, who is a T8 paraplegic, practicing yoga as tailored to his individual needs.

Private yoga instruction is certainly more rare these days. Most people assume yoga is synonymous with "group exercise classes", when traditionally it was taught on a one-to-one basis for most of its history.

In Krishnamacharya's biography, Desikachar outlines his approach to theraputic yoga:
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"What Krishnamacharya understood so well is that to treat an individual as a unique, whole entity... All possible knowledge of that individuals physical, mental, family, social, cultural, and religious circumstances must be brought to bear.

Krishnamacharya emphasized that such healing relationships must be on a one-to-one basis. Once he began working with a student, he wouid see him or her usually once a week to monitor progress and to change the program as needed.
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The one-to-one relationship between teacher and student is essential not only for the suffering individual but, eventually, for any serious student of Yoga. This is because progress beyond a certain point requires the total concentration of teacher and student in the learning situation. There can be no distractions."
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Further on Desikachar states:
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"Yoga must be changed and adapted to individual needs and to different settings and societies. At the same time, there are aspects of this tradition which must be preserved because they offer insights into the nature of healing, enduring wisdom that can help us in ever-changing circumstances. It was one of the challenges that preoccupied my father-what to preserve, what to adapt."
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Interestingly, this is absolutely not how B.K.S Iyengar was taught by Krishnamacharya. In fact, almost the converse was true. There are many complex reasons for this, but perhaps that is for another post.

Yoga and surfing

Yoga has been around for thousands of years and has been used for both physical and spiritual purposes. In recent years, yoga has become increasingly popular as a form of exercise and as a way to improve physical performance in various sports. This is particularly true in surfing, where the ability to maintain flexibility and mobility is crucial for success.

One of the key benefits of individualized yoga for surfing is that it can help improve overall flexibility and mobility. This is important because surfing requires a wide range of movements, from paddling and pop-ups to carving and cutting. By incorporating yoga into a surfing training routine, surfers can improve their ability to move freely and with ease, which can help them perform better in the water.

In addition to improving flexibility and mobility, individualized yoga can also help surfers improve their balance and coordination. Surfing requires a high degree of balance and coordination, as surfers must navigate waves and maintain their position on the board. By practicing yoga, surfers can improve their ability to maintain balance and control their movements, which can help them ride waves more effectively.

Individualized yoga can also help surfers reduce the risk of injury. Surfing can be a physically demanding sport, and injuries are common among surfers. By practicing yoga, surfers can improve their overall strength and stability, which can help protect them from common surfing injuries like sprains and strains.

In addition to the physical benefits of individualized yoga for surfing, it can also have mental and emotional benefits. Surfing can be a mentally challenging sport, and many surfers experience anxiety and stress while in the water. By incorporating yoga into their routine, surfers can improve their ability to stay focused and calm under pressure, which can help them perform better in the water.

Overall, individualized yoga can be a valuable tool for improving surfing performance and maintaining the mobility and flexibility needed for success in the water. By incorporating yoga into their training routine, surfers can improve their physical abilities, reduce the risk of injury, and improve their mental and emotional well-being.

Yoga for Chronic Pain

Yoga for Chronic Pain

Yoga has long been recognized as a powerful tool for managing chronic pain. By incorporating various postures, breathing techniques, and meditation, yoga can help individuals with chronic pain find relief and improve their overall quality of life. However, not all forms of yoga are equally effective for managing chronic pain. In this blog post, we will explore the role of individualized yoga therapy in treating chronic pain.

One of the key benefits of individualized yoga therapy is that it is tailored to the specific needs of the individual. Unlike a typical yoga class, where the instructor may lead a group through a set series of postures, individualized yoga therapy focuses on creating a personalized plan that takes into account the unique needs and abilities of the individual. This can include modifications to postures and other techniques to make them more accessible and comfortable for the individual.

Another benefit of individualized yoga therapy is that it is typically conducted in a one-on-one setting, allowing the therapist to provide personalized attention and support. This can be particularly helpful for individuals with chronic pain, who may have difficulty participating in group classes or may feel more comfortable working with a therapist in a private setting.

In addition to the physical benefits of yoga, individualized yoga therapy can also help individuals with chronic pain manage the psychological and emotional aspects of their condition. Through the use of mindfulness and meditation techniques, individuals can learn to better manage their stress and anxiety, which can in turn help reduce their chronic pain.

One of the key challenges of managing chronic pain is finding a treatment approach that works for the individual. Because chronic pain is a complex condition that can be influenced by a variety of factors, including physical, emotional, and psychological factors, a one-size-fits-all approach is unlikely to be effective. Individualized yoga therapy offers a personalized approach that can help individuals with chronic pain find relief and improve their overall quality of life.

If you or someone you know is living with chronic pain, consider exploring the benefits of individualized yoga therapy. A qualified therapist can help you create a personalized plan that takes into account your unique needs and abilities, and can support you in finding relief from chronic pain.

Experiential Knowledge

Experiential Knowledge

Yoga is an embodied practice that involves experiential learning.

Having a sound theoretical framework is very useful but not sufficient for the practice to be realised.

A great thought experiment that always resonated with me in this regard is "Mary in the Black and White Room".

The premise is this;

"Mary is a scientist, and her specialist subject is color. She knows everything there is to know about it. The wavelengths. The neurological effects. Every possible property that color can have. But she lives in a black and white room. She was born there and raised there. And she can only observe the outside world on a black and white monitor. And then one day someone opens the door. And Mary walks out. And she sees a blue sky. And at that moment, she learns something that all her studies couldn't tell her. She learns what it *feels* like to see color."

What this thought experiment teaches us is that there is a gap between intellectual knowledge, and experiential knowledge.

My experience in physiotherapy school privileged understanding theoretical mechanisms. Ironically, most of the pathoanatomical reasoning I learnt at uni in relation to pain and its causation has now been debunked, while simultaneously we were not encouraged as students to participate in embodied movement practices- the very thing we are supposed to be experts at prescribing.

We are taught to read research literature, and determine intervention effect sizes based on population averages (for a subjective endpoint), rather than explore the subjectivity around movement from a 1st person perspective.

This knowledge gap I experienced first hand as a persistent pain patient, which eventually led me to yoga, whereby I gained an appreciation for the importance of experiential knowledge. Particularly the interactions I had with my first yoga teacher Kale, who was an experiential "expert", something I hadn't encountered in my physiotherapy journey.

I think a balanced approach to integrating and reconciling 3rd person experimental science with 1st person introspective movement practice is ideal. We shouldn't grossly neglect one while privileging another.

Back bending as proprioceptive training

Back pain is one of the most common anatomical locations for persistent pain. It is also an anatomical area that falls outside the visual field. Therefore, as humans we rely on our proprioceptive mechanisms to give us a sense of position in space, and non visual mechanisms to communicate safety and threat signals to the brain.

BKS Iyengar, the famous Indian yoga teacher, made the following observations about the spine in relation to back bending.

"Backbends are not poses meant for exhibitionism. Backbends are meant to understand the back parts of our bodies. The front body can be seen with the eyes. The back body cannot be seen; it can only be felt. That’s why I say these are the most advanced postures, where the mind begins to look at the back, first on the peripheral level, then inwards, towards the core.

For a yogi, backbends are meant to invert the mind, to observe and to feel—first the back, then the consciousness and the very seer. Through the practice of backbends, by using the senses of perception to look back, and drawing the mind to the back portion of the body, one day meditation comes naturally."

Interestingly, there is evidence to suggest that persistent pain distorts visuospatial perception {1}

Disturbed perpetual awareness of the back is correlated with distress, fear avoidant beliefs, and catastrophizing cognitions about pain. Higher levels of disturbed self-perception are related to increased sensitivity to pressure at the low back [2].

Disrupted perceptual awareness of the back significantly and uniquely contributes to pain intensity.
Suprisingly, disturbed body perception appears to be more strongly associated with pain intensity than psychological distress, fear avoidance beliefs, or an objective measure of lumbar spine sensitivity [2].

Planning and coordination of movement requires an intact perception of the body and its position in space, and movement quality may be compromised if body perception is disrupted. Suboptimal movement patterns might abnormally load the back and contribute to nociceptive input and movement-related pain in those with chronic lower back pain {2].

It has also been hypothesized that danger signals may arise centrally as a result of incongruence between predicted and actual sensory feedback associated with movement by virtue of disrupted body maps {2}. This mechanism might also contribute to the pain experience in people with CLBP whose perception of the back is degraded.

Pain emerges when we conclude our body to be under threat and in need of protection so how the body is perceived should be seen as fundamental to the emergence of pain. In support of this idea are data that show that sensitivity to experimental pain is increased when perception of the body part is distorted by visual manipulation.

Loss of sensory precision and decreased ability to accurately localize sensory input could enhance sensitivity by increasing the salience and threat value of any sensory information, noxious or otherwise, received from the affected area.

Importantly, preliminary data suggest that strategies that likely improve self-perception such as mirror visual feedback and sensory discrimination training may decrease activity-related pain in people with chronic back pain {2}.

In Light on Yoga, Iyengar recommends using a mirror in the “Hints and Cautions” section of the book, prior to describing the asanas.

“When you are doing the asanas in front of a mirror, keep it perpendicular to the floor and let it come down to ground level, for otherwise the poses will look slanting due to the angle of the mirror. You will not be able to observe the movements (or placing of the head and shoulders in the topsy-turvy poses) unless the mirror reaches down to the floor.”

There is also experimental evidence for the role of Iyengar yoga in persistent back pain, demonstrating improvements in functional disability, pain intensity, and depression {3}. The exact mechanisms contributing to this improvement are likely multifactorial, with improvements in visuospatial awareness being simply one variable related to many others (beliefs, cognitions, psychological state etc).

REFERENCES:

  1. Sumitani, M & Shibata, Masahiko & Iwakura, T & Matsuda, Y & Sakaue, G & Inoue, Takaya & Mashimo, T & Miyauchi, Satoru. (2007). Pathologic pain distorts visuospatial perception. Neurology. 68. 152-4. 10.1212/01.wnl.0000250335.56958.f0.

  2. Wand, B. M., Catley, M. J., Rabey, M. I., O'Sullivan, P. B., O'Connell, N. E., & Smith, A. J. (2016). Disrupted self-perception in people with chronic low back pain. Further evaluation of the fremantle back awareness questionnaire. The Journal of Pain, 17(9), 1001–1012.

  3. Williams, Kimberly & Abildso, Christiaan & Steinberg, Lois & Doyle, Edward & Epstein, Beverly & Smith, David & Hobbs, Gerry & Gross, Richard & Kelley, George & Cooper, Linda. (2009). Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain. Spine. 34. 2066-76. 10.1097/BRS.0b013e3181b315cc.

Pelvic mobility. East Vs West

Pelvic mobility

Pelvic morphology (shape) differs across the globe, with mean population differences found in different gene pool groups. For example;

-        Acetabular inclination angle in Indians, on average, is 37° [1]

-        While the normal value in European literature is taken as 45° [2]

Reductionist anatomical and biomechanical reasoning may suggest that this is significant in a yoga context. The argument is that as cup angles of inclination reaches 45 degrees or more, this may be one possible factor that could impact internal and external rotation, potentially becoming apparent with hip flexion greater than 60 degrees.

This in theory would result in on-average differences between students with Western European ancestries and Indian ancestries, in both:

-        How long it may take to achieve certain poses, and;

-        The type of stimulus required to achieve certain poses.

Poses implicated here include, Padmasana, Baddha Konasana, leg behind the head poses, and advanced poses like Mulabandhasana and Kandasana.

Firstly, why does this variation exist?

There is ample evidence that populations (both human and mammalian) living in different climates tend to have different body proportions, with cold‐adapted populations having relatively larger and stockier bodies, and populations in hot climates having smaller or more elongated bodies with relatively longer limbs (Weinstein, 2005; Tilkens et al., 2007; Weaver and Hublin, 2009, Betti et al., 2012, 2015).

This pattern is widespread in endotherm animals, with closely related species displaying larger body sizes and shorter extremities in colder environments, and it is often referred to as Bergmann's (1847) Rule (for body size) and Allen's (1877) Rule (for body and limb proportions).

After the expansion out of Africa and the colonisation of high latitude regions, it has been suggested that natural selection favoured more robust and stocky bodies with a lower surface‐to‐volume ratio, which helped maintain internal body temperature in cold climates.

Differential climatic adaptation might therefore have contributed in generating modern population differences in body proportions, body size, limb robusticity, and even pelvic shape (Trinkaus, 1981; Ruff, 1991, 1994; Holliday and Falsetti, 1995; Pearson, 2000; Stock, 2006; Weaver and Hublin, 2009).

Kurki (2013a) compared nine populations from various continents, and found a relationship between latitude and pelvic shape, whereby high‐latitude populations tend to have a transversally wider midplane and outlet and an inlet which is less deep antero‐posteriorly than mid‐ and low‐latitude populations. Betti et al. (2014) and Weaver (2002) found a significant relationship between temperature and the 3D shape of the ilium and of the whole pelvis, suggesting that both pelvic and canal shape have been partially shaped by local climatic adaptations, possibly through the effect of natural selection favouring thermally efficient body sizes and proportions.

Additionally, random accumulation of differences due to genetic drift and differential migration is an ever‐occurring process and can potentially explain a portion of phenotypic variation between human populations.

Implications for the existence of yoga asana traditions of South India practiced by Westerners:

Postures from Krishnamacharya’s South Indian yoga system, such Kandasana, Dwi Pada Sirsasana, or Mulabandhasana, may be far more readily accessible for certain body types, with a probabilistic tendency to favour equatorial genetic ancestry.

For example, Karnataka in India (Krishnamacharya’s region of birth) is an equatorial region which has a yearly average temperature of 32 degrees the climate is very warm to hot all year round, and is incidentally the origin of most modern forms of physical yoga).

Avoiding population average fallacies

Firstly, we have to be aware that these findings relating to pelvic morphology are population based averages, and genetic variance often has more in-group variability than between-group variability. Which is to say these are simply averages, and tell you nothing about any specific individual, as there is great variance either side of the mean distribution (think a bell curve).

Avoiding biomechanical extrapolation

While pelvic morphology, in theory, may offer a compelling reason to correlate differences we observe in individual mobility, this has an unreliable historical track record. For example, acromial morphology (scapular shape), was thought to be a predictor of shoulder pain, as a “hooked” or type 3 acromion appears to reduce subacromial space and increase impingement of tendons. However, now there is ample evidence that subacromial impingement is an invalid and unreliable measure and diagnosis, and there is no evidence that the shape of the acromion influences shoulder function.

Avoiding reductionism

Many factors play a role in joint mobility, and the relative flexibility of the muscles and soft tissue around a joint is one such factor. This muscle and tissue elasticity is modulated by the nervous and immune systems, so inputs into the  system (stress, negative beliefs about movement, lack of sleep, training and exercise history and lifestyle habits) potentially play a greater role than morphology alone.

Avoiding nocebic interpretations

Images of these varied pelvic shapes do not represent what living, adapting tissue with a muscular and nervous system complete with consciousness look like. The danger is placing arbitrary limitations on ourselves based on beliefs about a pelvic morphology, when in fact no one can truly know their full strength or mobility potential without assessing it empirically, and working on all the modifiable variables outside of morphology.

Understanding environmental and cultural inputs

Cultural norms relating to sitting on the floor, as opposed to sitting on chairs potentially has a large effect size on hip mobility, particularly during the formative years of childhood and adolescence. This may, arguably, play a greater role than body type in determining ones baseline hip range of motion.

Floor culture is still prevalent throughout much of India, and many parts of Asia, and there is ample anecdotal evidence (the author included) that shifting to sitting cross legged and squatting on the floor instead of sitting on chairs can slowly restore lost mobility around the hips and pelvis. (I have also heard of anecdotal reports of the converse being true, which is highly plausible). For more on this see this blog here

For Teachers and Students

An awareness of all the inputs that affect hip range of motion may help teachers Individualise yoga sequences for different physical morphology, different lifestyles, while recognising self-limiting beliefs, educating regarding the variability in time frames that it may take to achieve certain poses, and how these vary from person to person.

We could summarise this as not assuming one-size-fits-all teaching pedagogy, and that;

  • Population data does not generalise to any specific individual

  • Everyone is different, and poses and sequences (as well as mobility drills outside of asana practice) should be adapted to cater for these differences

  • One can never truly know their full capability without long term practice and dedication

  • Depending on your own unique circumstances (nature and nurture) achieving the pelvic mobility required for these techniques will require differing amounts of time.

For example when I first started yoga my the musculature around my hips was very inflexible.

The following pictures are from 2010 (I began practice in 2008)

For additional reference, my genetic profile is from North Western Europe. Sweden has an average temperature of 2.9 degrees Celsius.

Training tips to increase mobility

Weighted mobility, using agonist and antagonist contractions, with repetitions and long holds:. For example in baddha konasana below. It took me many years to get the knees on the floor.

Active lowering into front splits, side splits and pigeon

In addition to many more drills available, these type of mobility exercises can help one achieve the mobility required for the asanas, mudras and bandhas central to Hatha Yoga.

REFERENCES:
1. Singh, S., Kumar, S., Rohilla, S., & Maini, L. (2014). Functional anthropometric measurements of Indian pelvis. Journal of clinical orthopaedics and trauma5(2), 79–83. https://doi.org/10.1016/j.jcot.2014.05.001

2. Kummer FJ, Shah S, Iyer S, DiCesare PE. The effect of acetabular cup orientations on limiting hip rotation. J Arthroplasty. 1999 Jun;14(4):509-13. doi: 10.1016/s0883-5403(99)90110-9. PMID: 10428235.

3. Betti, L. (2017), Human Variation in Pelvic Shape and the Effects of Climate and Past Population History. Anat. Rec., 300: 687-697. https://doi.org/10.1002/ar.23542

 

Immune System Health: Myths vs facts

Immune System Health: Myths vs facts

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Multiple studies in humans and animals have demonstrated the profound impact that exercise can have on the immune system.

There is a general scientific consensus that regular bouts of moderate intensity exercise is beneficial for host immune defense, particularly in older adults and people with chronic diseases.

Regular physical activity and/or frequent structured exercise reduces the incidence of many chronic diseases in older age, including communicable diseases such as viral and bacterial infections, as well as non-communicable diseases such as cancer and chronic inflammatory disorders.

Key findings from human vaccination studies show heightened responses to bacterial and viral antigens following bouts of exercise.

Regular physical activity and frequent exercise appears to limit and delay aging of the immune system, providing further evidence that exercise is beneficial for immunological health.

Additionally, there is limited reliable evidence to support the claim that vigorous exercise heightens risk of opportunistic infections, as commonly believed. 

𝙍𝙚𝙛𝙚𝙧𝙚𝙣𝙘𝙚:

J Campbell,  J Turner (2018): Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Front. Immunol., 16 April Department for Health, University of Bath, Bath, United Kingdom

The low down on pain relief

How pain relief works and why a short-term fix is not always the best answer.

 

Pain relief is a decrease in the experience of pain. Your pain is at a certain level, you do something that reduces that pain, and then you are relieved of some, or sometimes all, of that pain. Pain relief is not to be confused with an improved pain tolerance which is an improvement in your psychological, behavioural and emotional response to pain.

 

Pain relief in a Physiotherapy context is usually associated with manual therapy. Manual therapy includes treatments such as manipulation, mobilisation and massage. Another modality commonly used by Physio’s is acupuncture, alternately called dry needling.

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Many have the belief that this sort of therapy “puts things back into place” or “releases tight tissues”, but this doesn’t appear to be the case. Long-lasting changes in the structure of the target tissues of manual therapy have not been identified in clinical studies. Furthermore, studies show inconsistency between clinicians in determining which areas need treatment. It also doesn’t really matter how or where you treat as the choice of technique doesn’t seem to meaningfully effect outcome. You can even apply manual therapy to a completely different area and achieve some pain relief in the part that’s sore!

 

You may be thinking to yourself, “Lee, I hear what you’re saying but I’ve had it done and it works. I felt much better after they did it, so it’s doing something!”. Well you’re right, it is doing something, just likely not what you think. So what is going on here?

 

The neuroscience of manual therapy and pain relief.

 

Manual therapy may have an affect on the tissues that are being manipulated, but this effect is transient (as in while it’s happening) and likely negligible part of the picture. The real effect it has is on the nervous system.

 

Firstly, if you believe that the therapy you're receiving is fixing the problem and that you don’t need to worry about it any more, your brain coordinates the release of neurotransmitters to dampen the experience of pain. Some of these include endorphins and endogenous opioids that have been shown to be more potent than morphine!

 

Furthermore, some manual therapists work in a manner that exposes you to a painful stimulus in graduated way so that with time it becomes less painful. This process is called conditioned pain modulation. To be clear though, the painful stimulus becomes less painful but not necessarily the movements that you’re having difficulty with! Basically it just means that your brain gets better at providing pain relief to whatever is being pressed on or rubbed.

 

Given that manual therapy doesn’t seem to have any lasting effects on the tissues involved, and the benefits are likely related to changes in beliefs and expectations around your pain, what is the point?

 

Well, you may learn that your pain can be modulated. This insight can be a huge benefit to some people who feel that they have no control over their pain. Secondly, given that there is no real specificity in how it should be applied, a helpful therapist could teach you how to provide your own pain relief so that you don’t need to keep coming back to see them. Things like foam rolling or leaning your weight into a lacrosse ball might be a way for you to achieve some pain relief without having to pay too much money for a health care professional to do it. You could even buy one of these, this fancy looking device is called a Backnobber. Nob on folks!

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What are the drawbacks?

 

Now that I’ve spoken about how manual therapy can be used, let’s talk about how it can’t be used.

 

Manual therapy, delivered by a therapist or yourself, does not load your tissues in a way that improves tissue health and capacity. If you want to improve the state and function of your tissue’s then you need to use them. By use them, I mean get them moving. As an example if you want to get better at walking, then you’ve got to walk!

 

You also don’t give yourself the opportunity to learn about pain and how best to respond to it. This brings me back to the important difference between pain relief and improved pain tolerance. The constant seeking of relief for unpleasant sensations doesn’t help build resilience to deal with inevitable future unpleasantness that we can’t relieve. Let’s be clear, i’m not saying that relief is never needed, but I do feel as though we live in a “relief culture” in which the option of just noticing the pain and finding ways to work around it until it passes is not really an option given to those seeking an answer to their pain.

 

In the same vein, by always moving away from pain you may give the pain more meaning than it’s worth. What you resist, persists. A large part of pain treatment is exploring how it feels and gradually decreasing the bearing it has on your life. Psychologically, it doesn’t appear to be helpful to engage in pain relief strategies that are primarily focussed on lessening the experience of pain when we should be learning that pain is a normal part of the human experience and confidently engaging with it.

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What can you do instead?

 

Another way to achieve the nervous system effects associated with manual therapy is by doing exercise and movement. This is called exercise-induced hypoalgesia and it basically means - less soreness after exercise. The same neurotransmitters associated with the pain-relieving effects of manual therapy are released when you exercise the part that’s in pain, and when you exercise more generally away from the part that’s sore. You can do this by engaging in general exercise of the body as well as specific exercise of the part that’s sore.

 

Can you see how this sounds very similar to how manual therapy works despite there being quite clear differences in how the tissues are involved? On one hand the tissues are being moved because you are using them and on the other the tissues are being moved because someone else is moving them for you. Think of how rich the movement experience is when you do it, compared to the movement experience delivered by someone else. They can’t move you the way that you move you.

 

The similar theme between the two options is that you have a brain that is learning that the sore part is being treated and no longer poses a threat, so it flushes the system with pain-modulating neurotransmitters.

 

Furthermore, remember how I spoke about conditioned pain modulation and how over time the pushing and rubbing becomes less painful? Well, conditioned pain modulation in a movement setting goes hand in hand with a graded-exposure to the movements and activities that you are having difficulty with.

 

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Just in the same way that someone pressing on your body gets less painful with time, so too does performing a movement that you’re currently unable to do due to pain. Therefore, shouldn’t we get straight to it and start to challenge the body in the way that it will need to be used to do the things that are meaningful for you, outside the clinic?

 

 

Despite having some usefulness, pain relief through manual therapy doesn’t appear to have as many benefits as pain relief through movement and exercise. Also, pain relief in the short-term doesn’t always equate to a better outcome in the long-term and at times, shouldn’t be the focus of treatment. Lastly, a focus on improving pain tolerance through changing your psychological, emotional and behavioural response to pain, may be a part of building resilience to ease long-term suffering and this may not be achieved with therapy focussed on pain relief.

 

This is why sometimes it’s ok to feel the same at the end of the session, even a bit worse, if it’s known to both you and the therapist that it’s because you’re working your way towards an understanding of pain that is helpful and building the capacity of your body so that it can support you in doing the things you want to be able to do.

 

Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2008;2009;). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531-538. doi:10.1016/j.math.2008.09.001

 

Koltyn, K. F., Brellenthin, A. G., Cook, D. B., Sehgal, N., & Hillard, C. (2014). Mechanisms of exercise-induced hypoalgesia. Journal of Pain, 15(12), 1294-1304. doi:10.1016/j.jpain.2014.09.006

 

Vaegter, H. B., Handberg, G., & Graven-Nielsen, T. (2014). Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain, 155(1), 158-167. doi:10.1016/j.pain.2013.09.023

 

Vigotsky, A. D., & Bruhns, R. P. (2015). The role of descending modulation in manual therapy and its analgesic implications: A narrative review. Pain Research and Treatment, 2015, 292805-11. doi:10.1155/2015/292805

WHAT IS SELF-EFFICACY AND WHY DOES IT MATTER

WHAT IS SELF-EFFICACY AND WHY DOES IT MATTER

By Lee Schneider

Put simply, self-efficacy is the belief that you have the capacity to perform tasks and achieve goals.

 When put like this, self-efficacy is a bit of an umbrella term. Saying something like “John has high self-efficacy” is similar to saying something like “john is quite confident”. The thing is, we aren’t really saying what he thinks he’s good at, only that he is generally confident in his abilities.

 

Therefore, I’d like to talk about task-specific self-efficacy. For example, someone could have a high athletic self-efficacy but a low self-efficacy for public speaking. Furthermore, a single person can have a high self-efficacy for public speaking at a friend’s wedding but low self-efficacy public speaking at a university lecture.

 

So self-efficacy is both person-sensitive and context-sensitive, meaning that both the person’s traits and the environment they find themselves in is important.

 

 

There are four key environmental influences that may influence a person’s self-efficacy.

 

The first is whether you have performed the task, or similar tasks, in the past successfully - A trained archer should feel more confident in hitting a bullseye from 20m than someone who has never fired an arrow before.

 

The second is whether you have seen other people, who you deem to be similar enough in capacity to you, perform the task successfully - If you have never fired an arrow from a bow before and you watch another newbie hit a bullseye, then your belief that you can hit a bullseye goes up.

 

Thirdly, if other people that you trust tell you that you can do it, you are more likely to believe that you can - If the instructor says that they have seen many newbies like yourself hit a bullseye during their first session then your confidence will be increased.

 

Lastly, your physiological response to the task informs your self-efficacy too. If you start to feel sick in the stomach and get the shakes, or you get a wave of energy and excitement, then this will feed back into your beliefs about your capacity to perform the task.

 

So your self-efficacy for tasks is influenced by your previous exposure to the task, watching others do it, being told you can do it and the way that you feel prior to, and during, the performance of the task.

 

 

Self-efficacy and pain

 

Self-efficacy can be related to pain also. In the example above, successful completion of the task was hitting the bullseye with an arrow fired from a bow. In pain self-efficacy, successful completion of the task may be performing the task without pain.

 

If you have the belief that when you perform a certain task it will be painful then you have lower self-efficacy that you can perform that task pain-free.

 

However, it is slightly more complicated than this. The task has to be something meaningful to you and the pain has to be at a level where it is either preventing you from performing the task or is making the task unpleasant enough for it to negatively impact your wellbeing.

 

For example, you may cringe at the thought of doing a back-bend, but it also might not be very high on the list of meaningful tasks you need to perform. Furthermore, a rock climber might have the belief that they will get sore fingers from climbing but it doesn’t affect their desire or capacity to go climbing as they know that sore hands is part of the game, at least early on.

 

 

Where self-efficacy and pain is relevant is when you have the belief that you can’t perform a task that is meaningful to you due to pain, or you have the belief that when you perform the task the pain is bad enough for it to really affect your wellbeing.  

 

How might this belief form?

 

Say your job requires you to work at a desk for three hours a day, but you have the belief that you can only work for an hour before your neck pain starts to impact your work. This would suggest you have low pain self-efficacy for the task of performing three hours of desk work.

 

You will most likely have experiential evidence for this belief in that past experiences of you trying to perform this task has resulted in a sore neck.

 

You may have witnessed other people in your office have neck pain when they sit for long periods and see that you are in a similar enough situation to them.

A health care professional or someone you trust may have told you that working at a desk for too long “stuffs up your neck”.

 

Lastly, you may feel anxious and worried when you go to sit at your desk to start work and this will feed back into your belief that you can’t do it.

 

 

Why does it matter?

 

This is important. It matters because your beliefs inform your actual experience of the task that you’re trying to perform. That is, what you believe is going to happen ends up shaping what perceive as happening. Let’s be clear here. I’m not saying that everything you believe comes true. What I am saying is that your beliefs are important in determining the way that you perform a given task and the sensory information that your brain attends to during the task.

 

The brain is a very clever machine. It is constantly making predictions about what it is likely to experience during a task and weighs these predictions against what actually happens as provided by sensory input. Sensory input is information carried by nerves from throughout the body to the brain that tell the brain what is happening in, and to, the body. So, the brain makes guesses about what these nerve fibers are going to deliver to it and compares those guesses to what they actually deliver.

 

Can you see that self-efficacy is really just a bunch of predictions about what you think is likely to happen when you do something?

 

The thing is, the brain is constantly getting it wrong. The world is far too complex and unpredictable for us to carry all the information needed to make 100% accurate predictions of events and their sensory consequences, in the circuitry of our brain. In fact, the brain probably never get it exactly right, rather a scale of wrong-ness. When the predictions it makes about what it is going to experience is wrong it can deal with this ‘prediction error’ in three different ways.

 

1)    It can learn and update its guesses for future encounters.

 

2)    It can choose to pay attention to sensations that confirms its guesses and ignore sensations that don’t.

 

3)    It can act upon the body to change sensations in a way that confirms its guesses.

 

 

Let’s put this in the context of pain using the neck pain example above.

 

If you make the prediction that you will experience neck pain when you sit at a desk for an hour you are more likely to experience that pain. Furthermore, the stronger your prediction the more likely that this will happen.

 

Let’s say that you’ve been sitting at the desk for 59 minutes without pain and look down at the clock to see that 59 minutes have passed since you sat down. At this point your neck is not providing sensory input that there is anything bad going on there, but due to the clock and your beliefs you have the prediction that it should be starting to hurt.

 

In this situation your brain can do one of the three things I mentioned above.

 

1)    It can learn from this scenario that it can sit for an hour without pain, thus updating it’s understanding of the capacity to perform this task without pain.

 

2)    It can selectively attend to sensory input that confirms the neck is in pain and ignore sensory input that says otherwise.

 

3)    It can change the activity of muscles and other systems to actively provide sensations that suggests there is pain. This may explain things like muscle “tightness” or muscle guarding in pain.

 

What I’m saying is that in certain situations, if your pain self-efficacy is low enough, your brain may actually change your experience to suit your beliefs rather than change your beliefs to suit your experience, which is clearly problematic. 

 

What do I do about it?

 

Clearly the first option the brain uses is more advantageous than the other two. It seems appropriate to update your understanding of the world than to engage in self-deception.


So, changing your predictions appears to be important and this can be done in a few ways, that so happen to mimic the influences on self-efficacy:

 

1) You can update your predictions experientially by doing the task, or similar tasks, successfully. You can even try to perform the task in alternative environments in the attempt to change contextual factors that influence the predictions you make.

 

2) You can watch another person do the task successfully and find similarities between you and that other person.

3) You can seek information that is positive, and challenge information that you have that is negative. This is a hard one as there is a lot of scary/dodgy information out there and without formal training it’s challenging to know what is relevant and what is just wrong and harmful. Given that information informs predictions, sometimes it’s best to seek advice from someone who can de-weight predictions that aren’t helpful and add weight to predictions that are helpful.

 

4) Finally, you can learn strategies to keep yourself calm and relaxed when confronted with a task that you feel you can’t perform without pain. There are many ways to do this such as slowing the breath, being mindful, softening the body and noticing unhelpful thoughts as they arise.

 

Mindfulness, education and movement

 

It seems likely that we have a brain that isn’t updating to new information, a collection of beliefs that aren’t helpful and a body that needs to move better.

 

Therefore, we should make the brain more receptive to the actual sensory consequences of the tasks we perform by practicing mindfulness and developing a non-judgmental awareness of the body. We should find, understand and live by information that frames predictions in a more positive light and disconfirm information that is negative. And, we should move the body regularly, and in a variety of ways, so that we have a body and brain that is conditioned to the physical and sensory consequences of lots of different ways to move and interact with the world.

 

This, is how you build self-efficacy.

 

 

 

References

 

Bandura, A. (1982). Self-efficacy mechanism in human agency. American psychologist37(2), 122.

 

Clark, A. (2013). Whatever next? Predictive brains, situated agents, and the future of cognitive science. Behavioral and brain sciences36(3), 181-204.

 

Den Ouden, H. E., Kok, P., & De Lange, F. P. (2012). How prediction errors shape perception, attention, and motivation. Frontiers in psychology3, 548.

 

Martinez-Calderon, J., Zamora-Campos, C., Navarro-Ledesma, S., & Luque-Suarez, A. (2018). The role of self-efficacy on the prognosis of chronic musculoskeletal pain: a systematic review. The Journal of Pain19(1), 10-34

 

Mosley, G. L., & Butler, D. S. (2017). Explain pain supercharged. NOI.

 

Ongaro, G., & Kaptchuk, T. J. (2019). Symptom perception, placebo effects, and the Bayesian brain. Pain160(1), 1.

Yoga in India. Post 1

Yoga in India. Post 1

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Demonstrating Hatha Yoga to the Haridwar locals. Haridwar is an ancient city and important Hindu pilgrimage site in North India's Uttarakhand state, where the River Ganges exits the Himalayan foothills. Haridwar is one of the four sites of Kumbh Mela, a mass Hindu pilgrimage of faith in which Hindus gather to bathe in the holy river. The festival is the largest peaceful gathering in the world. The Haridwar Kumbh Mela dates at least from the early 1600s, with earlier versions dating from 644 CE.

In my encounters here, most of the locals in this region of India's north were mostly practicing according to their orthodox Hindu customs- praying to Lord Shiva, and bathing in the Ganges.

The Sadhus, which were many in number, were engaged in various practices, from continuously reciting holy books, to smoking Charas (pictured below), to complete renunciation of material possessions (wandering naked with body paint).

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On a surface glance however, the practice of any distinctive Hatha Yoga seemed to be reserved for the plethora of schools and ashrams in nearby Rishikesh.


The reduction in overt practices of Hatha Yoga among the common people does have some historical basis, described in Theos Bernard's biography detailing his life in the 1930s:

"Hindus as well as Buddhists were persecuted by the Muslim occupiers, and the Hindu Tantricas were forced underground to practice in secret clans. Over the centuries many of their practices were lost as the holders of the oral tradition died and their foundational texts—hand-copied on palm leaves or birch bark—rotted in the monsoon climate or were devoured by termites. However, there was still a vast repository of Tantra that was widely practiced in reclusive Tibet, and Theos concluded that “everything indicated that the north [Tibet] was my goal.”

For instance, Muslim conqueror Timur invaded Haridwar in 1398, massacring countless pilgrims, while at an early version of Kumbh Mela.


The subjugation of Hatha Yoga is also epitomised in the 1935 letter by Theos' father, Glen Bernard:

“Heat. Dirty. Tropical. Hot month ahead. ...good stuff [Hatha Yoga knowledge] so scarce it must be looked for with a fine toothed comb.… Lots of ignorance and superstition. I begun my research by scouring the Imperial Library, the best in Asia, and visiting swamis at area temples; no good for practical Yoga, but good for philosophy and metaphors. So few now know yoga—[it’s] almost a thing of the past. Yoga can better be done in the States—[you] can find pundits there to help with the literature necessary for the path.”

Interestingly, Krishnamacharya makes the similar observations in his 1934 book Yoga Makaranda.

He speculates that the lack of interest in yoga in India at the time would result in "Westerner's" mastering it, and selling it back to India. My experience practicing in Haridwar in 2019 were that many of the locals were not practicing Hatha Yoga, but mostly engaged in the yoga of Bhakti, or “devotion".

From Krishnamacharya’s 1934 text: "For such achievements in yoga, we do not need to send our country’s money elsewhere to procure any items. Whatever money we get, there is plenty of place in our country to store it. The foreigners have stolen all the skills and knowledge and treasures of mother India, either right in front of us or in a hidden way. They pretend that they have discovered all this by themselves, bundle it together, and then bring it back here as though doing us a favour and in exchange take all the money and things we have saved up for our family’s welfare. After some time passes, they will try and do the same thing with Yoga. We can clearly state that the blame for this is that while we have read the books required for the knowledge of yoga to shine, we have not understood or studied the concepts or brought them into our experience. If we still sleep and keep our eyes closed, then the foreigners will become our gurus in Yoga... This is a very sad state.

The physical exercise that is yoga, this asana kriya that is with us is more than enough for us. The hut that we live in is enough. We don’t need excessive amounts of money for that. What yoga wishes for us is that we eat only the clean healthy food. The ability that our youngsters have to follow outsiders can also be used to follow the knowledge and skills of our country. I have complete faith in this. In schools, it is very important to have this yoga in the curriculum."

Furthermore, Krishnamacharya himself was forced to leave India and eventually travel north to Tibet to find himself a Hatha Yoga guru, spending the next 7 years studying with him.


The devotees I saw in Hardiwar were Shaivites (worshipers of Shiva), and you can see the massive Shiva statue in the background that sits on the banks of the Ganges.

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 A sect of Shaivanism, known as Kashmir Shaivanism lays out a six fold path including asana, pranayama, concentration, meditation and enlightenment, similar to Patanjali yoga. However I only witnessed the devotional and ritualistic aspects of the practice in my brief traveling.


As for Krishnamacharya’s efforts, the fact that the vast, vast majority of Hatha Yoga practiced today stems from Krishnamacharya's sole efforts at reviving it are a testament to his work, but also paradoxically contributed to the "Westernisation" of the practice that he so feared. As India got swept up in industrialisation, and chasing modern Western ideals, Hatha Yoga was not prioritized by the institutions. Meanwhile, the spiritual vacuum left after the Enlightenment bludgeoned Christianity's credibility meant that often the most enthusiastic yoga seekers arrived from outside India.

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In recent years however, one of the biggest advocates for popularising yoga among Indians nationals is current Indian Prime Minister Nahendra Modhi.

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Below is a series of quotes from Modi, listed on his official website:

"Yoga is one of the most precious gifts given by the ancient Indian sages to humankind": PM Modi
"Yoga is a passport to health assurance, a key to fitness and wellness": PM Modi

"Free from illness, a path to wellness –that is the path of Yoga": PM Modi
"Yoga makes us better individuals in thought, action, knowledge and devotion" PM Modi

"Practicing yoga helps fight stress and find peace": PM Modi
"Yoga goes beyond boundaries of age, gender, caste, creed, religion and nations": PM Modi
"In a world of excess, Yoga promises restraint and balance": PM Modi
"In a world of fear, Yoga promises hope, strength and courage": PM Modi

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Practicing on the banks of the Ganges, with Hindu mantras being chanted in the background, the breeze blowing from the Himalayas and the dedication and devotion to the "Divine" that saturates the atmosphere and the conscious lives of the inhabitants makes practicing Hatha Yoga here an overwhelming and unforgettable experience.

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By Scott White

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